Alcohol and blood pressure: the INTERSALT study

Marmot, Michael; Elliott, Paul; Shipley, Martin J.; Dyer, A. R.; Ueshima, Hirotsugu; Beevers, D. G.; Stamler, Rose; Kesteloot, Hugo; Rose, Geoffrey; Stamler, Jeremiah

doi:10.1136/bmj.308.6939.1263

Cited by 296 publications

(180 citation statements)

References 19 publications

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“…Several possible pathogenic pathways may relate alcohol consumption to chronic kidney failure. Alcohol consumption may increase the risk of kidney failure by initiating and/or promoting atherogenic risk factors, such as high blood pressure (31,32), hyperuricemia (33), insulin resistance (34), and diabetes (35). The finding in our study that adjustment for hypertension and diabetes strengthened rather than weakened odds ratios for ESRD associated with alcohol consumption may reflect a secondary reduction of alcohol intake by many patients who have received a diagnosis of hypertension or diabetes.…”

Section: Alcohol Consumption As a Risk Factor For Esrdmentioning

confidence: 43%

Risk of End-stage Renal Disease Associated with Alcohol Consumption

Perneger

Whelton

Puddey

et al. 1999

American Journal of Epidemiology

115

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Alcohol consumption has been linked to kidney disorders in selected patient groups, but whether it contributes to the burden of end-stage renal disease (ESRD) in the general population is unknown. The authors conducted a population-based case-control study to assess the relation between alcohol consumption and risk of ESRD. The study took place in Maryland, Virginia, West Virginia, and Washington, DC, in 1991. Participants were 716 patients who had started treatment for ESRD and 361 control subjects of similar age (20-64 years) selected by random digit dialing. The main risk factor of interest was self-reported consumption of alcoholic beverages (frequency of drinking days and number of drinks consumed per drinking day). In univariate analysis, consumption of alcohol exhibited a J-shaped association with risk of ESRD. The J shape disappeared after exclusion of persons who had ever consumed home-distilled whiskey ("moonshine") and adjustment for age, race, sex, income, history of hypertension, history of diabetes mellitus, use of acetaminophen, use of opiates, and cigarette smoking; however, the odds ratio for ESRD remained significantly increased (odds ratio = 4.0; 95% confidence interval: 1.2, 13.0) among persons who consumed an average of >2 alcoholic drinks per day. The corresponding population attributable risk was 9 percent. Thus, consumption of more than two alcoholic drinks per day, on average, was associated with an increased risk of kidney failure in the general population. A lower intake of alcohol did not appear to be harmful. Because these results are based on self-reports in a case-control study, they should be seen as preliminary. Am J Epidemiol 1999;150:1275-81. alcohol drinking; ethanol; kidney failure, chronic Prevention of end-stage renal disease (ESRD) requires knowledge of modifiable risk factors responsible for initiation and promotion of renal insufficiency (1). Modifiable risk factors for kidney failure that have been identified in population-based studies include high blood pressure (2), diabetes mellitus (3), exposure to occupational nephrotoxins (4), and chronic use of analgesics (5). However, known risk factors explain only a limited part of the overall incidence of ESRD.Alcohol consumption is a plausible risk factor for ESRD. Historically, alcoholism or intemperance was suspected of causing kidney failure by Richard Bright

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Section: Alcohol Consumption As a Risk Factor For Esrdmentioning

confidence: 43%

Risk of End-stage Renal Disease Associated with Alcohol Consumption

Perneger

Whelton

Puddey

et al. 1999

American Journal of Epidemiology

115

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“…29,86,87 Cardiovascular Disease. There are no consistent differences between women and men with regard to the relation between alcohol consumption and hypertension, [88][89][90][91][92][93][94][95] ischemic heart disease, 58,64,65,67,96 or stroke. 57,65,[69][70][71] Hypertension.…”

Section: Medical Risks Of Drinking For Women Compared With Menmentioning

confidence: 88%

Medical risks for women who drink alcohol

et al. 1998

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OBJECTIVE:To summarize for clinicians recent epidemiologic evidence regarding medical risks of alcohol use for women.METHODS: MEDLINE and PsychINFO, 1990 through 1996, were searched using key words "women" or "woman," and "alcohol." MEDLINE was also searched for other specific topics and authors from 1980 through 1996. Data were extracted and reviewed regarding levels of alcohol consumption associated with mortality, cardiovascular disease, alcoholrelated liver disease, injury, osteoporosis, neurologic symptoms, psychiatric comorbidity, fetal alcohol syndrome, spontaneous abortion, infertility, menstrual symptoms, breast cancer, and gynecologic malignancies. Gender-specific data from cohort studies of general population or large clinical samples are primarily reviewed. MAIN RESULTS:Women develop many alcohol-related medical problems at lower levels of consumption than men, probably reflecting women's lower total body water, gender differences in alcohol metabolism, and effects of alcohol on postmenopausal estrogen levels. Mortality and breast cancer are increased in women who report drinking more than two drinks daily. Higher levels of alcohol consumption by women are associated with increased menstrual symptoms, hypertension, and stroke. Women who drink heavily also appear to have increased infertility and spontaneous abortion. Adverse fetal effects occur after variable amounts of alcohol consumption, making any alcohol use during pregnancy potentially harmful. CONCLUSIONS:In general, advising nonpregnant women who drink alcohol to have fewer than two drinks daily is strongly supported by the epidemiologic literature, although specific recommendations for a particular woman should depend on her medical history and risk factors. L ess than three quarters of women in the UnitedStates drink alcohol, and those who do drink consume fewer drinks and less absolute alcohol than men. 1 However, at similar levels of self-reported alcohol consumption, the risk of psychosocial problems or dependence is greater for women than men (for definitions, see Appendix A). [2][3][4][5][6] Women also appear to develop alcohol abuse and dependence after fewer years of drinking than men. 7 Although only 4% to 5% of women in the U.S. general population meet criteria for past-year alcohol abuse or dependence, 8,9 9% of female primary care patients in some studies have reported recent heavy drinking or alcohol-related problems. 10,11 Many heavy drinkers decrease consumption following brief interventions that include explicit advice about safe drinking limits. [12][13][14] In addition, offering feedback about specific risks or consequences of their drinking to patients who drink heavily can help motivate them to decrease alcohol consumption or seek treatment. 15,16 Physicians report they would be more likely to advise patients about safe drinking practices if they were more confident of their knowledge about safe levels of alcohol consumption. 17 Women who drink more than two drinks daily on average, or who frequently drink five or more d...

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“…57 In Alcohol consumption: Higher levels of alcohol consumption are associated with increasing prevathe Pitt County Study after adjustment for age and energy intake, sodium intake did not vary markedly lence of hypertension and higher mean BP. 79 However alcohol consumption is usually found to be with socio-economic status, but sodium to potass-ium and sodium to calcium intake ratios decreased ment was not reported separately. None of the other studies has explored this possibility.…”

Section: Grade Occupation Ethnic Group Psycho-social Andmentioning

confidence: 95%

Socio-economic status and blood pressure: an overview analysis

Colhoun

Hemingway²,

Poulter³

1998

J Hum Hypertens

346

269

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Background: Mortality rates from hypertension relatedThe finding of an SES gradient in BP, despite adjusting for treatment in some studies and the lack of consistent diseases such as coronary heart disease, hypertensive heart disease, stroke and end stage renal disease show SES differences in hypertension treatment rates, makes differential treatment an unlikely explanation for the SES an inverse association with socio-economic status (SES). gradient in BP. A substantial part of the SES gradient was accounted for by the SES gradient in body mass Objectives: To review the published literature in order to assess whether (i) there is an association between index. Alcohol consumption across SES groups accounted for part of the association in men though few SES and blood pressure (BP), and if so whether this is explained by (ii) SES differences in treatment rates, or studies examined this issue specifically. In contrast, in undeveloped or developing countries a direct associ-(iii) SES differences in established risk factors for hypertension, or (iv) psycho-social factors associated ation between SES and BP has often been found which may reflect a higher prevalence of obesity, and higher with SES. Method: A narrative systematic review of published artsalt and alcohol intakes among those of higher SES. The SES differences in BP were not detectable in most studicles identified from a MEDLINE search from 1966-1996 and manual searching of the retrieved articles' biblioies in children. There is little evidence that adverse psycho-social factors associated with low SES cause graphies. Results: Lower SES was associated with higher mean chronic elevations in BP. Conclusion: A major challenge in reducing the SES BPs in almost all studies in developed countries. This inverse gradient was both stronger and more consistgradient in BP is to understand and prevent the SES differences in obesity, which are particularly large in ently found in women than in men. The magnitude of the association varied but generally was quite small, women. Future research should be directed to this question. with age adjusted mean systolic BP differences of about 2-3 mm Hg between the highest and lowest SES groups.

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Alcohol and blood pressure: the INTERSALT study

Cited by 296 publications

References 19 publications

Risk of End-stage Renal Disease Associated with Alcohol Consumption

Risk of End-stage Renal Disease Associated with Alcohol Consumption

Medical risks for women who drink alcohol

Socio-economic status and blood pressure: an overview analysis

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